L44- Female GUT Pathology III (vagina) Flashcards
Vagina:
- (1) size
- (2) simple definition, anatomically
- (3) embryonic origin
1- 2.5-3 in long
2- muscular tube between vulva and cervix
3:
- Mullerian ducts – upper 3/4ths vagina
- Urogenital sinus – lower 1/4th vagina
Uterine didelphys: definition and origin
- two uteri, two cervices, two vaginas
- TOTAL (not partial) failure of mullerian ducts to fuse
list the vaginal lesions (not vulva)
- Gartner’s duct cyst
- Adenosis, clear cell carcinoma
- SCC
list the vulva lesions (not vagina)
- Bartholin’s cyst
- nonneoplastic epithelial disorders
- condyloma acuminatum (genital warts)
- extramammary Paget’s disease
- VIN, SCC
Gartner’s duct cyst:
- (1) size and location
- (2) origin / cause
1- anterolateral wall of vagina, 1-2 cm
2- mesonephric / wolffian ducts
Vaginal Adenosis is seen in girls at (1) age, with mothers with a (2) history. (3) is the development seen in the vaginal wall due to (4) dysfunction. (5) is the risk in some females.
1- 10 y/o
2- diethyl stillbesterol (DES) regimen during pregnancy to prevent abortion
3- endocervical type glands
4- inhibition of Mullerian epithelial transformation into squamous epithelium
5- clear cell adenocarcinoma (10-35 y/o)
SCC of the Vagina:
- (un-/common)
- (2) cause, with (3) lesion initially
- (4) mass description
- (5) is also evaluated
- (good/poor) prognosis
1- uncommon
2- high risk HPV [16, 18, 31, 33]
3- vaginal intraepithelial neoplasia (VIN 1,2,3)
4- exophytic, polyploidal, fungating mass
5- pelvic / inguinal LNs
6- poor prognosis
Sarcoma Botryoides:
- aka (1)
- (2) affected age group
- (3) general appearance (based on name)
1- embryonal rhabdomyosarcoma
2- <5y/o
3- Botryoides = ‘bunches of grapes’ hanging w/in vagina
Sarcoma Botryoides:
- aka (1)
- (low/high) malignant
- (3) microscopic appearance
- (4) type invasion / spread
- (5) Tx
1- embryonal rhabdomyosarcoma 2- highly malignant 3- maligant rhabdomyoblasts, cambium layer, fibromyxomatous 4- local invasion 5- surgery, chemotherapy
list the components of the vulva
- labia majora, minora
- vestibule
- clitoris
- Bartholin glands (open into vaginal introitus/opening)
- Skene glands (around urethral opening)
Vulvar Vestibule components
- vaginal opening = introitus
- urethral opening
- major vestibular / Bartholin’s glands
- minor vestibular glands, periurethral Skene’s ducts (homologues of prosate gland, immediately adjacent and posterolateral to urethral)
Bartholinitis:
- (1) definition resulting from (2)
- (3) causes
- (4) and (5) may develop
- (6) Tx
1- acute inflammation, inferior labia majora
2- Batholin gland obstruction
3- Strep. spp, Staph. spp, Gonococci, E. Coli
4- vaginal blocking
5- abscess formation
6- drainage and marsupialization (special surgery)
Condyloma acuminatum = _____ + description
Genital Warts: bulky, warty growth
- possibly multiple
- hyperplasia, koilocytosis
Leukoplakia:
- (1) definition
- (2) causes
- (3) clinical importance
1- white plaques associated with pruritus and scaling
2: (neoplastic and non-neoplastic)
- inflammatory dermatoses (psoriasis)
- Lichen sclerosus, squamous cell hyperplasia
- Neoplasia: vulva intraepithelial neoplasia (VIN), Paget’s disease, invasive carcinoma
3- biopsy to r/o neoplastic cause
Lichen sclerosus = (1):
- (2) common age of onset
- (3) type disease pathogenesis
- (4) risk of carcinoma
1- Kraurosis vulvae
2- postmenopausal
3- autoimmune nature
4- slightly inc risk of carcinoma over leukoplakia alone
Lichen sclerosus morphological changes
- thinning of epidermis
- Rete Peg disappearance
- Dermal fibrosis (dense collagen)
- band-like inflammatory infiltrates
-**Leukoplakia: scaly white plaques, parchment like
Squamous Cell Hyperplasia on vulva = (1):
- (2) common age of onset
- associated with (3) symptom
- (4) malignant potential
1- Lichen simplex chronicus
2- post-menopausal
3- pruritus and chronic irritation of vulva
4- NONE
Squamous Cell Hyperplasia of vulva morphological changes
- acanthosis, localized hyperplastic epidermis, hyperkeratosis
- inflammatory infiltrates
- inc mitotic activity, no atypia
Paget disease of vulva:
- (1) = primary
- (2) = secondary
1- adenocarcinoma in-situ or invasive
2- due to underlying malignancy –> GYN, GI, GU in 15-30% cases
list VIN risk factors (include age), classic type
(vulvar intraepithelial neoplasia)
- HPV 16, 18, 31, 33 (high risk)
- mean age ~40 y/o
- smoking
- immunosuppressed patients
VIN, classic type:
-(1) is main appearance with a (2) distribution
(vulvar intraepithelial neoplasia)
1- Leukoplakia, reddish brown plaque
2:
- 50-80% multifocal
- 50-60% synchronous lesions in cervix, vagina, urethra, anus
VIN, classic type:
- (1) odds of recurrence after local Tx, more likely in (2) patients
- (3) risk of invasion after Tx
- (4) is the ultimate Tx
(vulvar intraepithelial neoplasia) 1- 35-50% 2- younger patients 3- 4-7% 4- surgical excision
VIN, differentiated type:
- (1) main cause
- (2) mainly affected group
(vulvar intraepithelial neoplasia)
1- p53 mutation (not HPV)
2- older women
VIN, differentiated type appearance / make-up
(vulvar intraepithelial neoplasia)
- basal atypical layer - basal cell atypia
- maturation of superficial layers, hyperkeratosis
- in-site lesion w/o invasion
Carcinoma of Vulva:
- (1) most affected group
- mostly (2) type in (3) location and (4) character
- (5) are also investigated in these cases
1- >60y/o 2- SCC: keratinizing, basiloid types (keratin pearls, intracellular bridges) 3- anterior 2/3 labia majora 4- plaque or nodule or ulcer 5- inguinal and pelvic nodes
Vulva SCC, keratinizing type:
- (more/less) common than than basaloid SCC
- mostly (older/younger) females
- (uni/multi)-focal
- (rare/common) associated multifocal lower GUT neoplasia
- (5) morphology
- (rare/common) associated VIN
- (7) associated HPV
- (rare/common) associated vulvar dystrophy
- (9) IHC markers
1- more, 80% 2- older 3- usually unifocal (or multifocal) 4- rare 5- keratinizing 6- rare (differentiated type) 7- HPV-β (cutaneous)- 5, 8 8- common 9- p53+ (some cases), p16(+/-)
Vulva SCC, basaloid type:
- (more/less) common than than keratinizing SCC
- mostly (older/younger) females
- (uni/multi)-focal
- (rare/common) associated multifocal lower GUT neoplasia
- (5) morphology
- (rare/common) associated VIN
- (7) associated HPV (+ type)
- (rare/common) associated vulvar dystrophy
- (9) IHC markers
1- less, 25% 2- younger 3- multifocal 4- common 5- worly 6- common (classic type) 7- HPVα- 16 > 18 8- rare 9- p53-, p16+
list the different Gestational trophoblastic disease- **indicate the main marker
- Hydatidiform mole- complete/incomplete
- invasive mole
- gestational choriocarcinoma
- placental site trophoblastic tumor
-**β-hCG in urine, serum is critical marker
define hydatidiform mole
Uterus:
- filled with translucent grape-like clusters of edematous, distorted structures
- deficiency of fetal BVs (no fetal development)
Hydatidiform mole:
- (1) age/geographic risk factors
- (2) types
- (3) 3 key characteristics
1- extremes of age, Far East countries
2- partial or complete
3:
i) large edematous, avascular villi
ii) stroma degeneration
iii) trophoblast proliferation
Complete Mole:
- (1) genomic status of ovum
- (2) morphological changes
- (3) physiological marker
- small risk of developing (4)
1- loss of chromosomes of ovum –> fertilized by 2 sperm or 1 diploid sperm => mostly 46XX, rarely 46XY
2- (embryo dies early, no fetal parts seen) enlarged uterus filled with grape like vesicles
3- β-hCG (may produce bilateral theca lutein cysts)
4- choriocarcinoma (2%)
Partial Mole:
- (1) genomic status of ovum
- (2) morphological changes
- (3) malignancy risk
1- fertilized by two (23X, 23Y) sperms => triploid (69XXY) mole
2- (short embryo development, some fetal parts seen) minimally enlarged uterus
3- no risk of malignancy
Hydatidiform mole:
- (1) main signs and Sxs
- (2) can develop after 3-4 mos
1- amenorrhea (enlarged uterus), vomiting, positive pregnancy test
2- vaginal bleeding, grape-like structures
Hydatidiform mole:
- (1) US appearance
- (2) physiological test
- (3) Tx
- (4) monitoring
1- snowstorm appearance, absent fetus if complete
2- elevated β-hCG, serum/urine
3- curettage for lesion removal
4- β-hCG levels (10% persistent/invasive, 2% choriocarcinoma)
Invasive mole:
- (1) frequency
- (2) definition
- (3) associated features
- (4) is important risk / development
- (5) Tx
1- 10% of complete moles
2- deep invasion of villi, trophoblasts –> myometrium
3- necrosis, hemorrhage of myometrium
4- uterine rupture (requires hysterectomy) –> villi embolize in the lung (regress)
5- chemotherapy
Gestational Choriocarcinoma:
- (1) geographic risk
- 50% develop from (2), 25% from (3)
1- more in Asia, Africa than USA
2- hydatidiform mole
3- abortion, normal pregnancy, ectopic pregnancy
Gestational Choriocarcinoma:
- (1) mass description
- (2) usual presentation
- (3) Tx
1- not bulky, uterine bleeding
2- advanced presentation –> lung, vagina, brain, kidney affected
3- evacuation + chemotherapy
Gestational Choriocarcinoma:
- (1) are malignant, (2) are absent
- (3) is initial screening followed by (4)
- (5) monitoring
1- cytotrophoblasts, syncitiotrophoblasts
2- chorionic villi
3- β-hCG elevated
4- biopsy
5- β-hCG
